LIMITATION OF LIFE-SUPPORT - FREQUENCY AND PRACTICE IN A LONDON AND ACAPE-TOWN INTENSIVE-CARE UNIT

Objectives: To examine the frequency of limiting (withdrawing and with holding) therapy in the intensive carl unit (ICU), the grounds for lim iting therapy, the people involved in the decisions, the way the decis ions are implemented and the patient outcome Design: Prospective surve y, Ethical approval was obtained, Setting: ICUs in tertiary centres in London and Cape Town. Patients: Ali patients who died or had life sup port limited, Interventions: Data collection only. Results: There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 35 4 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p = 0.6) Of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p = 0.014) and mean APACHE II scores 18.5 and 22.6 (p = 0.19) respectively. The m ost common reason for limiting therapy in both centres was multiple or gan failure. Both medical and nursing staff were involved in most deci sions, which were only implemented once wide consensus had been reache d and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn, The mea n lime from admission to the decision to limit therapy was 11.2 days i n London and 9.6 days in Cape Town, The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively, Conclusions: Withdrawal of therapy occurred commonly, most often because of multiple organ fa ilure. Wide consensus was reached before a decision was made, and the time to death was generally short.